Paper short abstract:

In this paper I will reframe the history of the WHO's concept of Community Based Rehabilitation for people with disabilities. Drawing on evidence from Kenya and Tanzania, I scrutinise the novelty of this concept and look at why its implementation was ultimately far removed from its initial aims.

Paper long abstract:

Einar Helander described the rehabilitation of people with disabilities as the 'fourth component' of the Alma Ata Declaration, next to promotion, prevention and cure. He developed the concept of Community Based Rehabilitation (CBR) at the WHO headquarters in the late 1970s. This supposedly new paradigm was to introduce a bottom-up approach to the development of rehabilitation services in the so-called developing countries, introducing a more participatory approach that could be adapted to local circumstances.

With Kenya and Tanzania as case studies, I contextualise this history of CBR within a longer timeframe, focusing on what actually happened on the ground. I contend that this longer and more grounded history of the 'fourth pillar' of Alma Ata can tell us a lot about what happened when these ambitious programs 'travelled', and their transformation between the stages of conceptualisation and actual implementation. In Kenya and Tanzania, CBR was introduced in contexts where ideas about and practices of rehabilitation had developed since late colonial times. This first of all meant that CBR was not something radically new, but also that its implementation had to be negotiated between a multitude of actors: The state, philanthropic, humanitarian and religious organisations, and of course people with disabilities themselves. That process made for a considerable discrepancy between the idea and the implementation of CBR. This paper will thus contribute to a better understanding of how to interpret ambitious PHC programs such as CBR within longer histories of rehabilitation on the African continent.